Provider Demographics
NPI:1760556898
Name:WILCOX, CYNTHIA JOYCE (BS)
Entity Type:Individual
Prefix:MISS
First Name:CYNTHIA
Middle Name:JOYCE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:BS
Other - Prefix:MISS
Other - First Name:CINDY
Other - Middle Name:JOYCE
Other - Last Name:WILCOX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:1507 ARIZONA DR
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130
Mailing Address - Country:US
Mailing Address - Phone:505-356-9075
Mailing Address - Fax:
Practice Address - Street 1:300 E 1ST
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130
Practice Address - Country:US
Practice Address - Phone:505-359-1221
Practice Address - Fax:505-359-1075
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator